Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Monday, January 02, 2012

Giving Thanks to a Rule-Breaker

The call never should have been made.

It broke every proscribed rule.

After all, I was not on call. Thanks to the wonders of computer technology, it was very clear that I was being covered by my colleague. And yet, despite this, it came.

“Dr. Fisher, I’m so sorry for calling you at home, but I received a call from Ms. X, the wife of your patient Mr. Y. who said she really needed to speak to you about her husband... she seemed quite concerned and insisted I call you…. I told her I’d see if I could reach you at home… I’m so sorry, but it sounded urgent… I have her number, could I connect you?”

“That would be great, thank you…”

I wish I got the name of the operator that evening. I have no idea what intuition, what verbal cue she received that prompted her to break all the rules. She was, after all, just a hospital operator who should have followed the playbook but decided to take a huge personal risk to rely on her judgment instead. There was no playbook, no algorithm involved – in fact, it was just the opposite.

But one thing’s for certain: this operator should to know that the patient, his family, and I will be forever grateful.

8 comments:

To me this is just more evidence that medicine needs to change and embrace the era of participatory medicine. A patient's spouse with a critical concern shouldn't be considered lucky to have spoken to a physician.

The CEO of the ACC, Dr. Jack Lewin, would refer to this as pushing volume over quality. Once physicians submit to the ACO model of medicine where all patients and doctors are equal and interchangeable components in a health care machine which operates on a fuel of 'guidelines', patients will feel comfortable with any health care surrogate. Personal relationships with patients must end as our new health care system is implemented. Health care workers must be comfortable doing what is right for society over the individual patient. Please, get with the guidelines!

Tom B said, "... this is just more evidence that medicine needs to change...' In case you misunderstand the situation, the "colleague" who was on call was "a physician." So, the patient's wife had no problem talking to "a physician." She was put through to "the physician", Wes, for some reason that Wes felt was important. Unless you can produce a physician who can be on call 24/7/365, they have to be OFF call sometimes. I have had the experience of taking call weeks in a row. It doesn't help your skill, your asttitude, or your family life. You people seem to think there are more than 24 hours in a day and forget that doctors have more than one patient at a time. Call your man Obama since he knows more about medicine than we doctors. I sincerely hope you experience medical care as he is shaping it. You may have to do it without physicians, though. Maybe you'll get the guy who took the 3 Months to Becoming a Medical Providercourse. How will that hope and change work out for you?

A patient's spouse with a critical concern shouldn't be considered lucky to have spoken to a physician.

As a point of clarification, the patient's wife would have spoken with the physician on call. That was not the issue here. Rather, the operator recognized the wife's need to speak with the doctor with whom she had a prior relationship - the one who knew both her and her husband best.

By "participatory medicine," I hope you're implying that medicine of tomorrow needs to value the sanctity of the doctor-patient relationship. If so, then you get my drift.

Anon: Perhaps you have never been on the patient end of the medical system. As a professional, graduate school educated individual who has had the misfortune to require several intensive hospitalizations over several years for a myriad of problems - let me educate you. Not all patients and doctors are "equal and interchangeable components." The value of the doctor/patient relationship cannot be overemphasized. For anyone with a complex medical history, having the confidence that the treating physicians from various specialties can communicate with one another and the patient often on a continuing basis, sometimes in emergent situations, is what this patient believes quality healthcare is all about. An "interchangeable doctor" is unable to know the nuances and interpret the unspoken signs frequently picked up by those with whom the patient has a confident, secure relationship.The ACO model suggests that patients will feel comfortable with ANY health care surrogate? NO, they won't.

Anonymous said, "An "interchangeable doctor" is unable to know the nuances and interpret the unspoken signs."I suggest that the only way you're going to have your doctor be available to you 24/7/365 is to hire your own exclusive physician. Even if a doctor could be continuously available, you might call when they are tied up for hours with another patient. So, you'll have to have one all to yourself. Now, if you keep your Michael-Jackson-like personal physician up for 2 or 3 night in a row, he/she won't remember all those little nuances you expect. He'll be exhausted. Soon he'll be divorced, penniless, and crazy due to working all the time. Doctors have to have down time and sleep just like everyone else. Residents in training are even restricted in how many hours they can work without rest. I'm not sure how that trains them to take care of patients like you who expect continuous coverage.

Yes, in Utopia, everyone sees the same physician every time, day or night. The physicians need no rest, and everything is known about how the human body functions and reacts.

Either temper your expectations to the real world or look for a one-way ticket to Utopia, or, as Michael Moore might suggest, Cuba or Venezuela!

Physicians need a break, the FAA recently promulgated mandatory periods of rest for pilots. Are physicians not entitled to similar considerations?Marcus Welby was fiction, practicing physicians are real they are entitled to rest periods like pilots and their patients

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.